Healthcare Provider Details

I. General information

NPI: 1508783010
Provider Name (Legal Business Name): ANJALI RAHEJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 PAXTON AVE STE 12A
CINCINNATI OH
45209-2441
US

IV. Provider business mailing address

2721 MORGAN WAY UNIT 302
CINCINNATI OH
45212-2573
US

V. Phone/Fax

Practice location:
  • Phone: 937-414-7776
  • Fax:
Mailing address:
  • Phone: 937-414-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028588
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: